Methods and devices for surgical access

Abstract

An apparatus for positioning a patient during surgery includes a surgical table frame having a longitudinal dimension and a centerline, and at least one laterally movable support mounted thereon that includes longitudinal rails and transverse rails, and one or more modular body supports mounted on the surgical table frame. The laterally movable support includes a pair of platforms where one platform is laterally translatable relative to the other platform on a plurality of tracks between the platforms, the lateral translation being to one or both of the left and the right of the centerline.

I claim: 
     
       1. An apparatus for positioning a patient during surgery comprising:
 a surgical table frame having a longitudinal dimension, and at least one laterally movable support mounted thereon, 
 (a) wherein the surgical table frame comprises: two or more longitudinal rails that are laterally spaced from a centerline between them and two or more transverse rails that transect the longitudinal rails, and one or more modular body supports mounted on the surgical table frame, and 
 (b) wherein the laterally movable support comprises at least two components comprising a pair of substantially planar platforms comprising:
 (i) a support platform comprising on an upper surface two or more opposing bolsters that are laterally spaced relative to the centerline, the support platform comprising on a back surface engagement elements for engaging the support platform; and 
 (ii) a laterally translatable platform comprising on an upper surface a plurality of tracks that are engageable with the engagement elements on the back surface of the support platform, and comprising on a back surface adjustable and releasable surgical table engagement elements; 
 
 wherein the laterally translatable platform is mounted on the surgical table frame by engagement of the adjustable and releasable surgical table engagement elements with any one or more of the transverse and longitudinal rails; and 
 wherein a centerline of the path of the plurality of tracks is substantially parallel to the longitudinal dimension of the table, and wherein the support platform is translatable either left or right off the centerline. 
 
     
     
       2. The apparatus for positioning a patient during surgery according to  claim 1 , wherein the laterally movable support further comprises one or more of
 a. An actuator for moving the support platform relative to the pivot platform, the actuator selected from a crank and a pusher/puller; 
 b. a displacement guide for selecting the extent of displacement of the support platform from centerline; and 
 c. a locking element for releasably locking the position of the support platform. 
 
     
     
       3. The apparatus for positioning a patient during surgery according to  claim 1 , wherein the apparatus is adapted for receiving a body of a patient positioned thereon in one of a prone and supine position. 
     
     
       4. The apparatus for positioning a patient during surgery according to  claim 1 , wherein the support platform is configured on the surgical table frame to support a body part comprising hips and wherein modular body supports are configured on the surgical table to support each of head, abdomen and feet. 
     
     
       5. An apparatus for positioning a patient during surgery according to  claim 1 , wherein the opposing bolsters on the support platform are configured to elevate the supported portion of the a body of a patient positioned on the table. 
     
     
       6. An apparatus for positioning a patient during surgery according to  claim 1 , wherein the support platform comprises a pad layer and wherein the engagement elements on the back surface of the support platform comprise one of wheels and bearings. 
     
     
       7. The apparatus for positioning a patient during surgery according to  claim 4 , wherein the relative motion of the laterally translatable platform is arcuate around a radius of curvature that is adjustably selectable and defined by a circle centered on the modular body support configured on the surgical table to support feet. 
     
     
       8. An apparatus for positioning a patient during surgery according to  claim 7 , wherein the laterally translatable platform is pivotably translatable and wherein the plurality of tracks comprises arcuate tracks having a radius of curvature that ranges from 20 to 60 inches. 
     
     
       9. An apparatus for positioning a patient during surgery according to  claim 7 , wherein the laterally translatable platform is selected from an array of laterally translatable platforms each having plurality of arcuate tracks that correspond with a radius of curvature for a particular patient population, the array including at least one laterally translatable platform having a radius of curvature that ranges from 20 to 30 inches, at least one laterally translatable platform having a radius of curvature that ranges from 30 to 40 inches, and at least one laterally translatable platform having a radius of curvature that ranges from 40 to 60 inches. 
     
     
       10. An apparatus for positioning a patient during surgery according to  claim 7 , wherein the laterally translatable platform is rotated either left or right off the centerline from between 10 degrees and 60 degrees. 
     
     
       11. An apparatus for positioning a patient during surgery comprising:
 a surgical table frame and at least one pivoting support mounted thereon, 
 a) wherein the surgical table frame comprises: two or more longitudinal rails that are laterally spaced from a centerline between them and two or more transverse rails that transect the longitudinal rails, and one or more modular body supports mounted on the surgical table frame, and 
 b) wherein the pivoting support comprises at least two components comprising a pair of substantially planar platforms comprising:
 i) a support platform comprising on an upper surface two or more opposing bolsters that are laterally spaced relative to the centerline, the support platform comprising on a back surface engagement elements for engaging the support platform with a pivot platform; and 
 ii) a pivot platform comprising on an upper surface a plurality of arcuate tracks that are engageable with the engagement elements on the back surface of the support platform, and comprising on a back surface adjustable and releasable surgical table engagement elements; 
 
 wherein the pivoting support is mounted on the surgical table frame by engagement of the adjustable and releasable surgical table engagement elements with any one or more of the transverse and longitudinal rails; and 
 wherein a centerline of the path of the plurality of arcuate tracks is substantially parallel to the longitudinal dimension of the table, and wherein the support platform is rotatable either left or right off the centerline. 
 
     
     
       12. The apparatus for positioning a patient during surgery according to  claim 11 , wherein the pivoting support further comprises one or more of:
 a. a pivoting actuator for moving the support platform relative to the pivot platform, the actuator selected from a crank and a pusher/puller; 
 b. a displacement guide for selecting the extent of displacement of the support platform from centerline; and 
 c. a locking element for releasably locking the position of the support platform, and 
 wherein the support platform comprises a pad layer and wherein the engagement elements on the back surface of the support platform comprise one of wheels and bearings. 
 
     
     
       13. The apparatus for positioning a patient during surgery according to  claim 11 , wherein the apparatus is adapted for receiving a body of a patient positioned thereon in one of a prone and supine position. 
     
     
       14. The apparatus for positioning a patient during surgery according to  claim 13 , wherein the pivoting support operates to enable positional adjustment of a portion of the body of a patient resting thereon, and wherein the support platform is actuatable by rotational movement around an axis that is perpendicular to the longitudinal rails along the path of the arcuate tracks of the pivot platform to displace a portion of the body of a patient resting on the support platform in the direction of rotation from left to right. 
     
     
       15. The apparatus for positioning a patient during surgery according to  claim 11 , wherein the support platform is configured on the surgical table frame to support a body part comprising hips and wherein modular body supports are configured on the surgical table to support each of head, abdomen and feet. 
     
     
       16. The apparatus for positioning a patient during surgery according to  claim 11 , wherein the relative motion of the pivoting support is arcuate around a radius of curvature that is adjustably selectable and defined by a circle centered on the modular body support configured on the surgical table to support feet. 
     
     
       17. An apparatus for positioning a patient during surgery according to  claim 11 , wherein the opposing bolsters on the support platform are configured to elevate the supported portion of the body positioned on the table. 
     
     
       18. An apparatus for positioning a patient during surgery according to  claim 11 , wherein the pivot platform is selected from an array of pivot platforms each having plurality of arcuate tracks that correspond with a radius of curvature for a particular patient population, the array including at least one pivot platform having a radius of curvature that ranges from 20 to 30 inches, at least one pivot platform having a radius of curvature that ranges from 30 to 40 inches, and at least one pivot platform having a radius of curvature that ranges from 40 to 60 inches, and wherein the support platform is rotated either left or right off the centerline from between 10 degrees and 60 degrees. 
     
     
       19. An method for positioning a patient during surgery comprising:
 (a) providing a surgical table that has affixed to it a laterally movable support, the surgical table and laterally movable support sharing a common centerline defined by a longitudinal axis of the surgical table, the laterally movable support comprising at least two substantially planar platforms comprising:
 (i) a support platform comprising on an upper surface two or more opposing bolsters that are laterally spaced apart relative to the centerline, the support platform comprising on a back surface engagement elements for engaging the support platform; and 
 (ii) a laterally translatable platform comprising on an upper surface a plurality of tracks that are engageable with the engagement elements on the back surface of the support platform, and 
 (iii) affixed on a back surface of the laterally translatable platform, an adjustable and releasable engagement elements for affixing the laterally movable support to the surgical table surgical table; 
 
 (b) positioning a patient on the surgical table in a prone position wherein a centerline of the patient is generally aligned with the common centerline of the table and the laterally movable support, 
 (c) positioning a portion of the patient comprising hips on the laterally movable support between the opposing bolsters, 
 (d) contacting the portion of the patient comprising hips with one or both of the opposing bolsters, the contacting comprising either passive contacting or elevating the contacted portion of the patient comprising hips; 
 (e) actuating lateral motion of the laterally movable support either left or right of the centerline to introduce a bend to the portion of the patient comprising hips from centerline of the patient. 
 
     
     
       20. An apparatus for positioning a patient during surgery comprising:
 a surgical table frame having a longitudinal dimension, and at least one modular body support and at least one laterally movable support mounted thereon,
 (a) wherein the surgical table frame comprises: two or more longitudinal rails that are laterally spaced from a centerline between them and two or more transverse rails that transect the longitudinal rails, and one or more modular body support mounted on the surgical table frame, 
 (b) wherein the at least one modular body support is configured on the surgical table to support each of head, abdomen and feet; and 
 (c) wherein the laterally movable support is configured on the surgical table frame to support a body part comprising hips and comprises at least two components comprising a pair of substantially planar platforms comprising:
 (i) a support platform comprising on an upper surface two or more opposing bolsters that are laterally spaced relative to the centerline, the support platform comprising on a back surface engagement elements for engaging the support platform; and 
 (ii) a laterally translatable platform comprising on an upper surface a plurality of tracks that are engageable with the engagement elements on the back surface of the support platform, and comprising on a back surface adjustable and releasable surgical table engagement elements; 
 
 wherein the laterally translatable platform is mounted on the surgical table frame by engagement of the adjustable and releasable surgical table engagement elements with any one or more of the transverse and longitudinal rails; and 
 wherein a centerline of the path of the plurality of tracks is substantially parallel to the longitudinal dimension of the table, and wherein the support platform is translatable either left or right off the centerline; and 
 wherein the apparatus is adapted for receiving a body of a patient positioned thereon in one of a prone and supine position.